Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.Enhanced recovery after bariatric surgery protocol (ERABS) decreased length of hospital stay (LOS) without influencing clinical outcomes. ERABS improved logistics aspects in operating room (OR) with OR time savings. Lean management was used to reorganize OR logistics and to improve its efficiency. This study analyzed clinical and OR logistic aspects in ERABS protocols.
Retrospective analysis of prospectively maintained database of obese patients undergoing bariatric surgery from 2017 to 2019 was performed. Since September 2018, patients were treated with ERABS protocol (ERABS group). All patients treated with a standard protocol between January 2017 and September 2018 (control group) were compared to ERABS group. Preoperative (anthropometric data, surgical and medical history) and intraoperative (type of procedure) were analyzed in two groups. LOS was the primary outcomes parameter analyzed; complications, readmissions and reoperations within 30 days were the secondary outcomes. Logistic endpoints were evl procedure time was a factor associated with complication (IRR 1.011; p?=?0.0008).
This study confirmed that ERABS protocol is safe and a feasible alternative with improved LOS. OR reorganization and logistic efficiency achieved using lean management helped reduce all OR times and these are likely related to the improvement in LOS and complication.
This study confirmed that ERABS protocol is safe and a feasible alternative with improved LOS. OR reorganization and logistic efficiency achieved using lean management helped reduce all OR times and these are likely related to the improvement in LOS and complication.Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), represent the standard of care for treatment of superficial gastrointestinal lesions. In 2012 a novel technique called underwater endoscopic mucosal resection (U-EMR) was described by Binmoeller and colleagues. This substantial variation from the standard procedure was afterwards applied at endoscopic submucosal dissection (U-ESD) and recently proposed also for peroral endoscopic myotomy (U-POEM) and endoscopic full-thickness resection (U-EFTR).
This paper aims to perform a comprehensive review ofthe current literature related to supporting the underwater resection techniques with the aimto evaluate their safety and efficacy.
Based on the current literature U-EMR appears to be feasible and safe. Comparison studies showed that U-EMR is associatedwithhigher "en-bloc" and R0 resection rates for colonic lesions, but lower "en-bloc" and R0 resection rates forduodenal non-ampullar where standardization of the technique is needed.Fluorescence-based enhanced reality (FLER) is a computer-based quantification method of fluorescence angiographies to evaluate bowel perfusion. The aim of this prospective trial was to assess the clinical feasibility and to correlate FLER with metabolic markers of perfusion, during colorectal resections.
FLER analysis and visualization was performed in 22 patients (diverticulitis n?=?17; colorectal cancer n?=?5) intra- and extra-abdominally during distal and proximal resection, respectively. The fluorescence signal of indocyanine green (0.2mg/kg) was captured using a near-infrared camera and computed to create a virtual color-coded cartography. This was overlaid onto the bowel (enhanced reality). It helped to identify regions of interest (ROIs) where samples were subsequently obtained. https://www.selleckchem.com/products/bay-293.html Resections were performed strictly guided according to clinical decision. On the surgical specimen, samplings were made at different ROIs to measure intestinal lactates (mmol/L) and mitochondria efficiency as acceptor contrd fluorescence signal in augmented reality and provides a reproducible estimation of bowel perfusion (NCT02626091).To evaluate the effectiveness of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) in superficial esophageal neoplastic lesions (SENL).
A comprehensive search for studies investigating the efficacy of ESTD and ESD for SENL was conducted to search for relevant studies through PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, and Wanfang.Weighted pooled rates were calculated for en bloc resection rate, R0 resection rate, operation time, dissection area, dissection speed, and adverse events. The 95% confidence intervals (95%CI) for effect size were used to calculate the pooled value using the fixed- or random-effects model.
A total of seventeen studies with 1161 patients were identified and included in the meta-analysis.The pooled analysis showed that ESTD had significantly higher en bloc resection (OR 3.98; 95% CI 1.74 to 9.12; p?=?0.001) and R0 resection rates (OR 2.29; 95% CI 1.54 to 3.46; p?&lt;?0.001) than ESD.The operation time in the ESTD group was shorter than that in the ESD group (SMD?=?-0.57; 95% CI -0.95 to -0.19; p?=?0.003). The dissection area of the ESTD group was larger than that in the ESD group (SMD?=?0.49; 95% CI 0.16 to 0.83; p?=?0.004), and the dissection speed is faster than that in the ESD group (SMD?=?1.52; 95%CI 1.09 to 0.83; p?&lt;?0.001). There were no significant differences in esophageal stenosis (p?=?0.94) between the two techniques. However, ESTD was superior to ESD in other adverse events (p?&lt;?0.05).
ESTD has a significant advantage over ESD in the treatment of SENL. ESTD has significantly higher en bloc and R0 resection rates and reduced adverse events.
ESTD has a significant advantage over ESD in the treatment of SENL. ESTD has significantly higher en bloc and R0 resection rates and reduced adverse events.Anastomotic leakage (AL) during Ivor-Lewis esophagectomy (ILE), owing to gastric conduit (GC) ischemia, is a serious complication. Measurement parameters during intraoperative ICG fluorescence angiography (ICG-FA) are unclear. We aimed to identify objective ICG-FA parameters associated with AL.
Patients?&gt;?18years with an indication for ILE were enrolled. ICG-FA was performed at the abdominal and thoracic stage, and data, such as time of fluorescence appearance, speed of ICG perfusion, quality of GC perfusion (good, poor, ischemic), blood pressure, baseline patient characteristics, GC dimensions, and other intraoperative parameters were collected. On postoperative day 4 to 6, Gastrografin swallow radiography was performed. AL development was classified based on the Clavien-Dindo and SISG severity classifications. Univariate analysis with a 95% confidence level (p?&lt;?0.05) was performed. Factors with p?&lt;?0.05 were included in the multivariate analysis.
100 patients were enrolled. During ICG-FA, evaluation of subjective perfusion was a very specific test (94.